        <table class="vertical_table" id='t_pupillometry'>
            <caption>Pupillometry (Treatment eye only)</caption>
            <thead>
				<tr>
                    <th colspan="3"><?php echo xl('Date'); ?></th>
                </tr>
				<tr>
                    <th colspan="3"><?php echo xl('Schedule'); ?></th>
                </tr>	
                <tr>
                    <th colspan="3">1. <?php echo xl('Pupil Size Minimun'); ?>:</th>
                </tr>
				<tr>
                    <th colspan="3">2. <?php echo xl('Pupil Size Maximum'); ?>:</th>
                </tr>
				<tr>
                    <th colspan="3">3. <?php echo xl('Puil Reacion'); ?>:</th>
                </tr>
				<tr>
                    <th colspan="3">4. <?php echo xl('Pupil Shape'); ?>:</th>
                </tr>
				<tr>
                    <th colspan="3">5. <?php echo xl('Pupil Location'); ?>:</th>
                </tr>
            </thead>
            <tbody>
				<tr>
					<td><input type='text' id='1_date_1' name='1_date_1'></input></td>
				</tr>
				<tr>
					<td><select type='text' id='1_scheduled_1' name='1_scheduled_1'>
						<option value='1' text='<?php echo xl('Day 1-2')?>'>
							<?php echo xl('Day 1-2')?>
						</option>
						<option value='2' text='<?php echo xl('Wk 1')?>'>
							<?php echo xl('Wk 1')?>
						</option>
						<option value='3' text='<?php echo xl('Mo 1')?>'>
							<?php echo xl('Mo 1')?>
						</option>
						<option value='4' text='<?php echo xl('Mo 3')?>'>
							<?php echo xl('Mo 3')?>
						</option>
						<option value='5' text='<?php echo xl('Mo 6')?>'>
							<?php echo xl('Mo 6')?>
						</option>
						<option value='6' text='<?php echo xl('Mo 9')?>'>
							<?php echo xl('Mo 9')?>
						</option>
						<option value='7' text='<?php echo xl('Mo 12')?>'>
							<?php echo xl('Mo 12')?>
						</option>
						<option value='8' text='<?php echo xl('Mo 24')?>'>
							<?php echo xl('Mo 24')?>
						</option>
						<option value='9' text='<?php echo xl('Unscheduled')?>'>
							<?php echo xl('Unscheduled')?>
						</option>
					</select></td>
				</tr>
				<tr>
					<td><input type='text' id='1_pupillometry_1' name='1_pupillometry_1'>mm</input></td>
				</tr>
				<tr>
					<td><input type='text' id='1_pupillometry_2' name='1_pupillometry_2'>mm</input></td>
				</tr>
				<tr>
					<td><select type='text' id='1_pupillometry_3' name='1_pupillometry_3'>
						<option value='1' text='<?php echo xl('Normal')?>'>
							<?php echo xl('Normal')?>
						</option>
						<option value='2' text='<?php echo xl('Abnormal')?>'>
							<?php echo xl('Abnormal')?>
						</option>
					</select></td>
				</tr>
				<tr>
					<td><select type='text' id='1_pupillometry_4' name='1_pupillometry_4'>
						<option value='1' text='<?php echo xl('Round')?>'>
							<?php echo xl('Round')?>
						</option>
						<option value='2' text='<?php echo xl('Elliptical')?>'>
							<?php echo xl('Elliptical')?>
						</option>
						<option value='3' text='<?php echo xl('Irregular')?>'>
							<?php echo xl('Irregular')?>
						</option>
					</select></td>
				</tr>
				<tr>
					<td><select type='text' id='1_pupillometry_5' name='1_pupillometry_5'>
						<option value='1' text='<?php echo xl('Center')?>'>
							<?php echo xl('Center')?>
						</option>
						<option value='2' text='<?php echo xl('Off Center')?>'>
							<?php echo xl('Off Center')?>
						</option>
					</select></td>
				</tr>
				

            </tbody>
        </table>